Psychosis Flashcards
1
Q
What is psychosis?
A
Term used to describe the characteristic complaints of several mental health problems, most notably diagnoses on the schizophrenia-spectrum (schizophrenia, schizoaffective disorder, delusional disorder, etc)
Simply = Term to indicate “loss of contact with reality.”
2
Q
Term used to describe the characteristic complaints of several mental health problems, most notably diagnoses on the schizophrenia-spectrum (schizophrenia, schizoaffective disorder, delusional disorder, etc)
Simply = Term to indicate “loss of contact with reality.”
This is known as…?
A
Psychosis
3
Q
What are the types of symptoms of psychosis?
List 2 points
A
It involves clusters of “symptoms” including:
- Positive symptoms (hallucinations, delusions)
- Negative symptoms (flat affect, avolition, lack of interest in social interactions).
4
Q
Hallucinations, Delusions
These are….?
a. Positive symptoms of psychosis
b. Negative symptoms of psychosis
A
a. Positive symptoms of psychosis
5
Q
Flat affect, Avolition, Lack of interest in social interactions
These are….?
a. Positive symptoms of psychosis
b. Negative symptoms of psychosis
A
b. Negative symptoms of psychosis
6
Q
True or False?
In the general population, psychosis symptoms are rare and problematic
A
False
In the general population psychosis symptoms are not rare and are generally unproblematic, but in some individuals, they can lead to considerable distress and reduction in functioning
7
Q
In some individuals, psychosis symptoms can lead to considerable ____ and ______
A
- distress
- reduction in functioning
8
Q
Why is there a delay in developing talking treatments for psychosis?
List 4 main reasons
A
- Psychological therapies for psychosis did not become widely investigated or accepted as potentially useful treatments until the 1990s
- Psychosis was seen as fundamentally different from neurosis
- Symptoms not seen as understandable in psychological terms (e.g.,
Karl Jaspers) - Lack of therapeutic optimism in the treatment of “schizophrenia”
9
Q
Psychological therapies for psychosis did not become widely investigated or accepted as potentially useful treatments until …?
A
The 1990s
10
Q
Psychosis was seen as fundamentally different from …?
A
Neurosis
11
Q
Why was there a lack of therapeutic optimism in the treatment of “schizophrenia”?
List 2 reasons
A
- There were poor results from early trials of psychotherapy
- Neuroleptics were. seen as the only viable treatment option
12
Q
- There were poor results from early trials of psychotherapy
- Neuroleptics were. seen as the only viable treatment option
This resulted in…?
A
Lack of therapeutic optimism in the treatment of “schizophrenia”
13
Q
What are the 5 Psychological therapies for psychosis?
A
- Rogerian/person-centred therapy
- Psychoanalytic therapies
- Cognitive Behaviour Therapy (CBT)
- Family therapy
- Interventions to reduce substance misuse
14
Q
How does Cognitive Behaviour Therapy (CBT) work?
List 4 points
A
- Activating event
(internal or external) - Thoughts (negative automatic thoughts, thought distortions, appraisals)
- Thoughts <–> Behaviour OR Thoughts <–> Feelings/Emotions
- Behaviours <–> Feelings/Emotions OR Feelings/Emotions <—> Behaviours
15
Q
The application (and adaptation) of the same basic principles to understand the distress and impairment caused by psychotic experiences
This is known as…?
A
Cognitive Behaviour Therapy for Psychosis (CBTp)
16
Q
Describe Cognitive Behaviour Therapy for Psychosis (CBTp)
A
The application (and adaptation) of the same basic principles to understand the distress and impairment caused by psychotic experiences
17
Q
Cognitive Behaviour for Psychosis (CBTp) is the application (and adaptation) of the same basic principles to understand the distress and impairment caused by …?
A
Psychotic experiences
18
Q
Cognitive Behaviour for Psychosis (CBTp) is the application (and adaptation) of the same basic principles to understand the ____ and ____ caused by psychotic experiences
A
- Distress
- Impairment
19
Q
The National Institute for Health and Care Excellence (NICE, 2014) defines CBTp as a psychological intervention where service users:
List 3 points
A
- Establish links between, thoughts, beliefs, perceptions and feelings in relation to their current or past symptoms and/or functioning (understand how problems happen)
- Re-evaluate their beliefs, perceptions and reasoning relating to target symptoms
- CBTp should involve development of alternative ways of coping with the target symptoms, and/or reduction of distress, and/or improvement of functioning
20
Q
The National Institute for Health and Care Excellence (NICE, 2014) defines CBTp as a psychological intervention where service users:
Establish links between, ____, _____, _____ and _____ in relation to their current or past symptoms and/or functioning (understand how problems happen)
A
- Thoughts
- Beliefs
- Perceptions
- Feelings
21
Q
The National Institute for Health and Care Excellence (NICE, 2014) defines CBTp as a psychological intervention where service users:
Re-evaluate their ____, ____ and ____ relating to target symptoms.
A
- Beliefs
- Perceptions
- Reasoning
22
Q
The National Institute for Health and Care Excellence (NICE, 2014) defines CBTp as a psychological intervention where service users:
Re-evaluate their beliefs, perceptions and reasoning relating to _______.
A
Target symptoms
23
Q
The National Institute for Health and Care Excellence (NICE, 2014) defines CBTp as a psychological intervention where service users:
CBTp should involve development of …?
List 3 points
A
- Alternative ways of coping with the target symptoms
- Reduction of distress
- Improvement of functioning
24
Q
What are the 4 basic CBTp strategies?
A
- Formulating (making sense)
- Normalising psychosis
- Improving coping
- Strategies to change unhelpful thoughts, beliefs, and appraisals
25
After appropriate goals for therapy are identified (e.g., which problem/symptom to target), the therapist carries out an assessment to...?
List 3 points
1. Identify thoughts, feelings, behaviours that are linked to the problem/symptom targeted
2. Help the client to see how these interact to maintain the problem in the present.
3. Create a shared understanding of how the problem developed and what could be done to resolve it.
26
After appropriate goals for therapy are identified (e.g., which problem/symptom to target), the therapist carries out an assessment to:
Identify ____, ____ and ____ that are linked to the problem/symptom targeted
1. Thoughts
2. Feelings
3. Behaviours
27
After appropriate goals for therapy are identified (e.g., which problem/symptom to target), the therapist carries out an assessment to:
Identify thoughts, feelings, behaviours that are linked to ...?
The problem/symptom targeted
28
After appropriate goals for therapy are identified (e.g., which problem/symptom to target), the therapist carries out an assessment to:
Help the client to see how thoughts, feelings, behaviours that are linked to the problem/symptom targeted interact to ...?
Maintain the problem in the present
29
After appropriate goals for therapy are identified (e.g., which problem/symptom to target), the therapist carries out an assessment to:
Create a shared understanding of how ...?
List 2 points
1. The problem developed
2. What could be done to resolve it
30
The therapist carries out an assessment to:
1. Identify thoughts, feelings, behaviours that are linked to the problem/symptom targeted.
2. Help the client to see how these interact to maintain the problem in the present.
3. Create a shared understanding of how the problem developed and what could be done to resolve it.
What part of CBTp do these relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
a. Formulating
31
How can we formulate psychotic experiences for hallucinations?
List 4 points
1. Triggers
(internal or external e.g., stress, sleep deprivation, isolation)
2. Auditory Hallucinations
3. Misinterpretation of Hallucinatory Experience
4. Mood & Physiology --> Auditory Hallucinations
OR
Safety Behaviours --> Auditory Hallucinations
32
What does ‘normalising psychosis’ mean?
Correcting common misconceptions about psychosis, its causes
and its consequences
33
Correcting common misconceptions about psychosis, its causes
and its consequences
What part of CBTp do these relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
b. Normalising psychosis
34
Challenging the stigma of psychosis
What part of CBTp do these relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
b. Normalising psychosis
35
Provision of more accurate information
What part of CBTp do these relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
b. Normalising psychosis
36
Promotion of accurate views about psychosis
What part of CBTp do these relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
b. Normalising psychosis
37
It’s a bit like teaching clients the same information you are learning at Uni but in a less academic way.
What part of CBTp do these relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
b. Normalising psychosis
38
List 5 definitions of ‘normalising psychosis’
1. Challenging the stigma of psychosis
2. Correcting common misconceptions about psychosis, its causes
and its consequences
3. Provision of more accurate information
4. Promotion of accurate views about psychosis
5. It’s a bit like teaching clients the same information you are learning at Uni but in a less academic way
39
How can we normalise psychosis?
List 4 ways
1. Making the experience understandable
2. They are not alone in experiencing certain feelings or thoughts
3. Psychoeducation
4. Personal disclosure (i.e., sharing your own experience)
40
How can we make the experience of psychosis understandable?
List 2 ways
1. Behaviours, thoughts, feelings are reactions to extreme adverse,
traumatic, stressful life events
2. Experiences exist within the range of human functioning and can be in the absence of distress or a mental health problem
41
What is Psychoeducation?
Learning about and understanding mental health, especially if it is a new experience for the individual
(e.g., providing reading material/information about psychosis)
42
Learning about and understanding mental health, especially if it is a new experience for the individual
(e.g., providing reading material/information about psychosis)
This is known as...?
Psychoeducation
43
Give 2 examples of Psychoeducation
1. Providing reading material
2. Providing information about psychosis
44
What. are the 5 myths about psychosis?
1. People with psychosis are dangerous
2. Psychosis is a diagnosis for life and there is no recovery
3. People with psychosis are unable to work
4. Psychosis always causes distress and people always need treatment
5. Psychosis is always a consequence of brain disease
45
People with psychosis are dangerous
True or False?
False
There is no evidence that people with psychosis are more dangerous or violent than the general population
46
Violence in psychosis is explained mostly by other factors such as...?
List 3 points
1. Substance misuse
2. Pre-existing history of violence
3. Criminal involvement
47
There is no evidence that people with psychosis are more dangerous or violent than the general population
Instead people are likely to be...?
Withdrawn or preoccupied with their own problems
48
True or False?
People with psychosis are much more likely to be the victim of violence rather than the perpetrator
True
49
Psychosis is a diagnosis for life and there is no recovery
True or False?
False
Psychosis is not necessarily for ever
50
What % of people have a single psychosis episode that
never occurs again?
a. About 50%
b. About 30%
c. About 10%
d. About 60%
b. About 30%
51
What % of people experience more than one episode even after long periods of being symptom-free?
a. About 50%
b. About 30%
c. About 10%
d. About 60%
b. About 30%
52
What % of people have persistent ongoing symptoms?
a. <25%
b. <17%
c. <42%
d. <33%
a. <25%
53
True or False?
Many people have a single psychosis episode that occurs sometimes (about 30%)
False
Many people have a single psychosis episode that never occurs again (about 30%)
54
True or False?
Some people experience more than one episode even after long periods of being symptom-free (about 30%)
True
55
True or False?
A majority of people have persistent ongoing symptoms (< 75%)
False
A minority of people have persistent ongoing symptoms (< 25%)
56
True or False?
People with psychosis are unable to work
False
There might be times when a person’s distress is such that it interferes with their ability to function, but this is not necessarily so
57
True or False?
Very few people who have experienced or currently experience symptoms of psychosis are able to work, have relationships and manage to function in their life
False
Many people who have experienced or currently experience symptoms of psychosis are able to work, have relationships and manage to function in their life
58
True or False?
Psychosis always causes distress and people always need treatment
False
Many people experience unusual beliefs or hear voices, but are not distressed by them
59
True or False?
Many people with psychosis experience unusual beliefs or hear voices, and are always distressed by them
False
Many people with psychosis experience unusual beliefs or hear voices, but are not distressed by them
60
Many people with psychosis experience unusual beliefs or hear voices, but are not distressed by them
How do they manage this?
Many people with psychosis make sense of their experiences in a way they can find helpful
(e.g., psychic experiences/ telepathy, reincarnation, etc.)
61
Many people with psychosis make sense of their experiences in a way they can find helpful
Give 2 examples of this
1. Psychic experiences/ telepathy
2. Reincarnation
62
True or False?
In some cultures, psychotic symptoms are viewed positively
True
63
True or False?
Psychosis is always a consequence of brain disease
False
Psychosis can be brought about by many experiences instead of only as a consequence of brain disease
64
Psychosis can be brought about by many experiences
List 6 factors of psychosis
1. Lack of sleep
2. Sensory deprivation
3. Substances or activities creating altered states of consciousness
4. Stressful events (hostage situations, combat stress and other life- threatening situations)
5. Bereavement
6. Trauma (bullying, abuse, head injury violence, etc.)
65
Coping strategy enhancements
What part of CBTp does this relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
c. Improving coping
66
True or False?
Often people have a limited range of effective/adaptive strategies to cope with or manage their psychotic experiences
True
67
Coping strategies enhancement consists of 2 things
What are they?
1. Review strategies the client already uses to cope with psychotic experiences, how often/when they are used and how effective they are.
2. Encourage the client to experiment with new coping strategies
68
1. Review strategies the client already uses to cope with psychotic experiences, how often/when they are used and how effective they are.
2. Encourage the client to experiment with new coping strategies
This is known as...?
Coping strategies enhancement
69
What are the 3 aims of Coping strategies enhancement?
1. To increase the coping strategies the client can use when facing distressing symptoms
2. To provide some respite
3. To encourage a greater sense of control
70
1. To increase the coping strategies the client can use when facing distressing symptoms
2. To provide some respite
3. To encourage a greater sense of control
These are the 3 aims of...?
Coping strategies enhancement
71
Give 3 examples of coping strategies
1. Understanding psychosis
2. Responding differently to symptoms
3. Reduce arousal and distress
72
1. Understanding psychosis
2. Responding differently to symptoms
3. Reduce arousal and distress
These are 3 examples of...?
Coping strategies (for psychosis)
73
How can we understand psychosis (e.g., relationship between inner speech and auditory verbal hallucinations)?
List 4 ways
1. Humming
2. Reading
3. Singing
4. Reducing sub-vocalisation (internal speech
typically made while reading) by filling mouth with water
74
How can we respond differently to symptoms?
List 3 ways
1. Acting assertively / dismiss the voice
2. “Making an appointment” with the voices
e.g. listening to the voices on a different day instead of today
3. Respond rationally to the voice content
75
How can we reduce arousal and distress?
List 4 ways
1. Listen to soothing music
2. Mindfulness meditation
3. Relaxation exercises
4. Use positive imagery/positive affirmations
(self-statements)
76
Reading
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
a. Understanding psychosis
77
Listen to soothing music
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
c. Reduce arousal and distress
78
Acting assertively / dismiss the voice
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
b. Responding differently to symptoms
79
Humming
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
a. Understanding psychosis
80
Singing
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
a. Understanding psychosis
81
Mindfulness meditation
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
c. Reduce arousal and distress
82
Relaxation exercises
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
c. Reduce arousal and distress
83
“Making an appointment” with the voices
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
b. Responding differently to symptoms
84
Reducing sub-vocalisation (internal speech
typically made while reading) by filling mouth with water
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
a. Understanding psychosis
85
Use positive imagery/positive affirmations
(self-statements)
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
c. Reduce arousal and distress
86
Respond rationally to the voice content
What coping strategy does this apply to?
a. Understanding psychosis
b. Responding differently to symptoms
c. Reduce arousal and distress
b. Responding differently to symptoms
87
Evidence suggesting that negative beliefs about psychosis (e.g., that these experiences are dangerous, uncontrollable or lead to catastrophic consequences) strongly predict ...?
List 2 things
1. Distress
2. Impairment
88
Evidence suggesting that ________ (e.g., that these experiences are dangerous, uncontrollable or lead to catastrophic consequences) strongly predict distress and impairment
Negative beliefs about psychosis
89
CBT therapists can use a range of strategies to change unhelpful beliefs of psychosis:
Belief: “If I don’t stop the voice, it will take over me and kill someone!”
Give 3 possible strategies
1. Use Socratic questioning in session
2. Ask clients to keep a log of recent voice hearing experiences
3. Evidence/counter evidence analysis
90
1. Use Socratic questioning in session
2. Ask clients to keep a log of recent voice hearing experiences
3. Evidence/counter evidence analysis
What part of CBTp do these relate to?
a. Formulating
b. Normalising psychosis
c. Improving coping
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
d. Strategies to change unhelpful thoughts, beliefs, and appraisals
91
1. Use Socratic questioning in session
2. Ask clients to keep a log of recent voice hearing experiences
3. Evidence/counter evidence analysis
These a possible strategies to ...?
Challenge unhelpful beliefs
92
Is CBT for psychosis effective?
Give 6 evidence from randomised controlled trials
1. Over 50 RCTs have examined the efficacy of CBT in people with psychosis, with positive findings across most “stages” of psychosis:
2. First episode psychosis / early psychosis (Tarrier et al. 2004)
3. Acute psychosis (Garety et al., 2008; Lewis et al., 2002)
4. People at risk of relapse (Gumley et al., 2003)
5. Treatment resistant psychosis (Durham et al., 2003; Turkington et al., 2008; Valmaggia et al., 2005).
6. Groups (Chadwick et al., 2000; Johns et al, 2002)
93
Over ___ Randomised Controlled Trials have examined the efficacy of CBT in people with psychosis, with positive findings across most “stages” of psychosis
a. 20
b. 9
c. 50
d. 75
c. 50
94
Over 50 Randomised Controlled Trials have examined the efficacy of CBT in people with psychosis, with ______ findings across most “stages” of psychosis
a. positive
b. neutral
c. negative
d. no
a. positive
95
According to Tarrier et al. (2004), CBTp is effective in _____ psychosis
a. First episode/ early psychosis
b. Acute psychosis
c. Risk of relapse
d. Treatment resistant psychosis
e. Groups
a. First episode/ early psychosis
96
According to Gumley et al. (2003), CBTp is effective in _____ psychosis
a. First episode/ early psychosis
b. Acute psychosis
c. Risk of relapse
d. Treatment resistant psychosis
e. Groups
c. Risk of relapse
97
According to Chadwick et al. (2000) and Johns et al. (2002), CBTp is effective in _____ psychosis
a. First episode/ early psychosis
b. Acute psychosis
c. Risk of relapse
d. Treatment resistant psychosis
e. Groups
e. Groups
98
According to Garety et al. (2008) and Lewis et al. (2002), CBTp is effective in _____ psychosis
a. First episode/ early psychosis
b. Acute psychosis
c. Risk of relapse
d. Treatment resistant psychosis
e. Groups
b. Acute psychosis
99
According to Durham et al.(2003), Turkington et al. (2008) and Valmaggia et al. (2005), CBTp is effective in _____ psychosis
a. First episode/ early psychosis
b. Acute psychosis
c. Risk of relapse
d. Treatment resistant psychosis
e. Groups
d. Treatment resistant psychosis
100
Several meta-analytic studies have considered the efficacy of CBT for psychosis
What do the findings show?
These meta-analyses have shown that CBT can alleviate psychotic symptoms, especially positive symptoms
101
Meta-analyses have shown that CBT can alleviate (reduce) psychotic symptoms, especially _______
Positive symptoms
102
True or False?
Meta-analyses have shown that CBT can increase psychotic symptoms, especially positive symptoms
False
Meta-analyses have shown that CBT can alleviate (reduce) psychotic symptoms, especially positive symptoms
103
What did Morrison et al. (2012; 2013) suggest about CBTp?
CBTp can be effective on its own, even in individuals who are not taking antipsychotic medication
104
CBTp can be effective on its own, even in individuals who are not taking antipsychotic medication
Who proposed this?
Morrison et al. (2012; 2013)
105
CBTp can be effective on its own, even in individuals who ...?
Are not taking antipsychotic medication
106
True or False?
CBTp cannot be effective on its own
False
CBTp can be effective on its own, even in individuals who are not taking antipsychotic medication
107
What does the National Institute for Health and Care Excellence (NICE, 2014) recommend for CBT?
CBT should be offered as a first-line treatment across the continuum of psychosis, regardless of high or low risk of psychosis
108
True or False?
CBT should be offered as the final treatment across the continuum of psychosis, regardless of high or low risk of psychosis
False
CBT should be offered as a first-line treatment across the continuum of psychosis, regardless of high or low risk of psychosis
109
CBT should be offered as a first-line treatment across the continuum of psychosis
What are the 3 points of the continuum?
1. People at clinical high risk (prodrome)
2. First episode psychosis
3. “Chronic psychosis” to promote recovery
110
What does the National Institute for Health and Care Excellence (NICE, 2014) recommend us to consider when treating people with psychosis?
To consider trauma
111
NICE also recommends that all people with psychosis should be assessed for _____ and ______
1. Trauma
2. Post-traumatic stress
112
NICE also recommends that all people with psychosis should be assessed for trauma and post-traumatic stress
They should also be offered ______ when appropriate
Trauma-focused psychological therapies (including CBT)
113
NICE also recommends that all people with psychosis should be assessed for trauma and post-traumatic stress.
They should also be offered trauma-focused psychological therapies (including CBT) when appropriate
But NICE suggests more research is needed into ...?
Their safety and efficacy in this specific population
114
True or False?
Psychosis symptoms are not uncommon and are generally unproblematic
True
115
Psychosis symptoms are not uncommon and are generally unproblematic
However, they can lead to considerable____ and _____ for some people
1. Distress
2. Reduction in functioning
116
What is CBTp is based on?
CBT principles
117
CBTp is based on CBT principles
What are they? (List 2)
1. Based on the appraisals of events, not the events themselves
2. Determine behaviours, thoughts, feelings and distress
118
True or False?
CBTp is ineffective for people who are not taking antipsychotic medication
False
CBTp is effective, even in people who are not taking antipsychotic medication
119
True or False?
CBTp is not recommended by NICE as a first line of treatment for psychosis
False
CBTp is recommended by NICE as a first line of treatment for psychosis
120
Who recommends CBTp as a first line of treatment for psychosis?
NICE (2014)
